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Etomidate
Related Subjects: |Respiratory Failure |Non invasive ventilation (NIV) |Intubation and Mechanical Ventilation |Critical illness neuromuscular weakness |Haemodialysis |Dobutamine
⚠️ Etomidate is an IV anaesthetic agent withdrawn for continuous ICU sedation because of increased mortality due to adrenocortical suppression (inhibition of 11β-hydroxylase). Still used for induction of anaesthesia, particularly in haemodynamically unstable patients. Always check the BNF link here.
📖 About
- Carboxylated imidazole compound (introduced 1972, Europe).
- IV anaesthetic & induction agent.
- Favoured in cardiovascularly unstable patients due to minimal effect on BP/HR.
⚙️ Mode of Action
- Short-acting IV anaesthetic.
- Inhibits 11β-hydroxylase (CYP11B1) → ↓ cortisol synthesis → adrenal suppression.
- At high concentrations also inhibits cytochrome P450 enzymes.
💊 Indications & Dose
- Adults: 0.15–0.3 mg/kg IV over 30–60 seconds.
- Elderly: 0.15–0.2 mg/kg IV over 30–60 seconds.
- Onset: 5–15 seconds. Recovery: 5–15 minutes.
- Max per dose: 60 mg.
🔗 Interactions
- See BNF.
⚠️ Cautions
- Shock, adrenal insufficiency, acute porphyria.
- Cardiovascular disease, fixed cardiac output, hypovolaemia.
- Elderly patients (increased sensitivity).
🚫 Contraindications
- See BNF.
❗ Side Effects
- Apnoea, hypotension, nausea, skin reactions.
- Involuntary muscle movements (myoclonus).
- Adrenocortical suppression (clinically significant with prolonged infusion).
- ↓ intracranial pressure, ↓ cerebral blood flow, ↓ cerebral oxygen demand.
📚 References
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